Provider Demographics
NPI:1225234958
Name:MINDYRGOINSDDSPLLC
Entity Type:Organization
Organization Name:MINDYRGOINSDDSPLLC
Other - Org Name:MID-CAROLINA DENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-759-8210
Mailing Address - Street 1:9336 BLAKENEY CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-759-8210
Mailing Address - Fax:
Practice Address - Street 1:9336 BLAKENEY CENTRE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-759-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902314Medicaid